Disparities Noted Between Academic and Non-Academic Glaucoma Centers

Ophthalmologist examining patient's eyes
Ophthalmologist examining patient’s eyes
Researchers advise working to ensure residency and fellowship training programs reinforce adherence to the American Academy of Ophthalmology’s preferred practices.

Significant racial, disease severity, and procedural differences exist for patients with primary open-angle glaucoma receiving care in academic settings compared with non-academic settings, according to research published in the American Journal of Ophthalmology.

Investigators conducted a retroscopic analysis of 3,707,084 eyes with primary open-angle glaucoma using Intelligent Research in Sight (IRIS®) registry data from 2016 through 2019. Among the cohort, 97% (n=3,597,164) experienced their initial visit in a non-academic environment, while the remaining participants (n=109,920) initially received care in an academic clinic. The team included demographic data, smoker status, insurance status, and glaucoma severity in their analysis. Researchers noted that academic settings served a higher portion of patients who were Black (27.0%) compared with non-academic settings (15.0%). They also observed higher instances of level 3 glaucoma severity among patients in academic centers compared with non-academic centers (26.92% vs 14.43%, P <.0001). Patients initially visiting academic centers had a higher likelihood of using government insurance (2.50%) or having missing or unknown insurance (8.49%). The team also observed that gonioscopy, pachymetry, and visual field testing were more frequently performed in conjunction with new patient visits in academic settings compared with non-academic settings (20.4% vs 10.7%; 22.7% vs 17.0%; 35.3% vs 24.3%, respectively). Procedures such as iSent and hydrus were also used about 2.5 times more frequently, and endoscopic cyclophotocoagulation (ECP) was used nearly 6 times more frequently in non-academic settings.

“Being more aware of differences, as well as similarities, could serve as a tool to address any disparities in care and disease progression but also address some very fundamental elements of glaucoma care, such as the importance of gonioscopy as part of a complete examination,” according to the researchers. “Despite the emphasis on gonioscopy by the Academy’s [Preferred Practice Patterns] for many years, studies, including our study, continue to suggest that gonioscopy continues to be underperformed. We should continue to work to ensure that residency and fellowship training programs (as well as continuing education activities and board certification and recertification processes) are designed to reinforce adherence to preferred practices and provide the clinical and surgical experiences that will prepare ophthalmologists to optimally serve their patients throughout their careers.”

Limitations of the study include its retroscopic nature and inability to establish level of visual field loss due to reliance on ICD-10 codes.

Disclosure: Some study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Skuta GL, Ding K, Lum F, Coleman AL. An IRIS® registry-based assessment of primary open-angle glaucoma practice patterns in academic versus non-academic settings. Am J Ophthalmol. Published online April 22, 2022. doi:10.1016/j.ajo.2022.04.006